Abstract
AimThis systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care.DesignSystematic review.Data SourcesIn July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID‐19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards.Review MethodsWe included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID‐19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non‐professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person.ResultsOf 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub‐themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership.ConclusionTo prepare for continuation of the COVID‐19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence‐based care to be provided in future.ImpactOur review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.
Highlights
The emergence of the SARS-CoV-2 virus (COVID-19) has highlighted the importance of the nursing profession and has challenged nursing practice
As part of the intervention development phase (Medical Research Council, 2008) of a trial testing a specific fundamental nursing care protocol for COVID-19, we undertook a systematic review of the impact of COVID-19, and other infectious conditions requiring isolation, on the provision of fundamental nursing care and the techniques required by nurses caring for these patients
We found several key concepts that cut across the identified barriers, in that many of the barriers could be addressed using multiple different adaptations, and that some adaptations addressed more than one barrier
Summary
The emergence of the SARS-CoV-2 virus (COVID-19) has highlighted the importance of the nursing profession and has challenged nursing practice. COVID-19 has required nurses to adapt their approaches to care due to redeployment (Bagnasco et al, 2020) from their usual environments to care for patients with this highly infectious virus. The COVID-19 pandemic has required nurses to implement unfamiliar practices, including but not limited to enhanced infection control procedures (Verbeek et al, 2020). P28 (Registered Nurses Association of Ontario, 2003) This highlights how nursing care can be a key determinant of patient experience (Graham et al, 2018; Murrells et al, 2013) and satisfaction (Aiken et al, 2017) and is causally linked to safety, clinical effectiveness, care quality and treatment outcomes including mortality and overall service use (Black et al, 2014; Darzi, 2008; Department of Health, 2013; Doyle et al, 2013; Vincent & Amalberti, 2016).
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